Early Outcomes of Lung Transplantation for COVID-19 Related Lung Disease. Single Center Experience

PURPOSE: Lung transplantation (LT) is a lifesaving treatment for Covid-19 related lung disease with early outcomes similar to other indications. METHODS: Seven patients underwent LT for Covid-19 related lung disease at our center: 5 for ARDS and 2 for IPF exacerbation post SARS-CoV-2 infection. RESULTS: Seven patients (5 men) with single organ failure underwent bilateral LT. Median age was 47 years old. All ARDS cases had poor lung mechanics on invasive mechanical ventilation with radiographic evidence of lung fibrosis: pneumatocele, GGO, consolidations, subpleural reticulations and traction bronchiectasis. vvECMO was bridge to transplant in 5 cases (bridge to recovery in 2). Median ECMO duration for ARDS was 32 days (range 7-99). Median time to LT from Covid diagnosis was 59 days (Q1-IQ3, 54-62). Two patients were post-partum women with ARDS. Explanted pathology showed UIP, DAD, diffuse hemorrhage and one case of fibrosing NSIP. Pulmonary hypertension was seen in 4 cases. One patient did not survive. Organizing pneumonia and granuloma were present in this patient. Most ARDS patients were unable to tolerate lower sedation and consent by a substitute decision-makers was obtained. Post operative ECMO decannulation was possible in all cases. Induction, maintenance immunosuppression and antimicrobials were standard for our program. Donated grafts were from deceased brain death donors and negative for 2019-nCoV. Rehabilitation potential and strong social support were absolute inclusion criteria. All survivors have excellent lung function. CONCLUSION: In the USA, over 130 LT have listed Covid-19 as the diagnosis indication. Although Covid-19 ARDS makes up for the majority of these LT, other diagnosis are post Covid pulmonary fibrosis and underlying fibrosis with SARS-CoV-2 induced exacerbation. LT for ARDS poses several challenges and is reserved for the minority of carefully selected patients dependent on extracorporeal life support. As others have reported, good short-term survival is described.